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Cut-out of the lag screw after fixation of trochanteric fractures with intramedullary devices like the Gamma Locking Nail is a well documented cause of late mechanical failure. Avascular necrosis of the femoral head after trochanteric fractures is an uncommon complication and several causes have been described.

As far as we know, the relation of the mechanical failure of fracture fixation and avascular necrosis of the femoral head in trochanteric fractures has never been described.

We present a study of six consecutive patients who underwent arthroplasty after cut-out of the lag screw fixation of a trochanteric fracture with Gamma Locking Nail. All six femoral heads were studied histologically and a clinical retrospective study was also performed.

In all cases, we found homogeneous avascular necrosis of the femoral head; in all but one, revascularisation was present in every area examined.

We suggest that after fixation …